An Unusual Presentation and Diagnosis of a Type 4 Middle Ear Paraganglioma: A Case Report

Abstract

We discuss the unusual presentation and subsequent diagnosis of a patient with a glomus tympanicum tumor, also known as middle ear paraganglioma, which is a rare and benign tumor of the middle ear that usually presents with pulsatile tinnitus, cranial nerve pathology, hearing loss, and dizziness. The patient was a 35-year-old female with no past medical or surgical history who presented with a three-year history of mild left-ear hearing loss. The initial examination was negative for otalgia or otorrhea but was notable for a mass filling her left ear canal. The patient denied pulsatile tinnitus or dizziness. CT imaging was used to examine the soft tissue mass in the middle ear and ear canal and was consistent with a soft tissue heterogeneous mass with a subsequent biopsy confirming a diagnosis of paraganglioma. After the diagnosis, a laser surgical excision was scheduled to remove the tumor. Constant awareness is needed to examine the different presentations of middle ear paragangliomas so that appropriate treatment is promptly provided.

Early Clinical Manifestations of Temporal Bone Paragangliomas: Two Case Reports

“…This may be accompanied by active secretion of catecholamines, which may have clinical implications. For example, such patients can be treated for a long time by general physicians, cardiologists, endocrinologists, and others 2,3 . Additionally, an ENT surgeon has to remember that in surgical intervention planning, it is necessary to determine the level of vanillylmandelic acid, metanephrines, and the total level of catecholamines in urine and/or blood plasma.…”

“…The second most common early symptom of temporal bone paraganglioma in typical cases at the beginning is auditory disorders as conductive hearing loss, which depends on tumour size and tumour connectedness with adjacent structures of the middle ear transformer mechanism 3,12,13 . With further tumour invasion into the inner ear, sensorineural hearing loss is added 14 .…”

“…At the same time, it was noted that progressive hearing loss sometimes prevents noise perception, which becomes less noticeable by the patient himself, and this is also explained by a decrease in the ability to perceive somatosensory tinnitus by the middle and inner ear structures. In parallel, vestibular dysfunction may occur, more often in the form of dizziness attacks (vestibular crises) even at the onset of the disease 3,15 , sometimes up to the complete loss of the peripheral component, as well as peripheral facial nerve partial palsy (paresis).…”